Program takes new approach to pain management

Sep. 12, 2013, 8:19 AM

Tobi Fishel, Ph.D., left, and Tracy Jackson, M.D., are leading a new rehabilitation program that aims to improve how chronic pain is treated. (photo by Susan Urmy)

Patients with chronic pain who are covered by the Vanderbilt Employee Health Care Plan or workers’ compensation system can now enroll in an innovative rehabilitation program that could dramatically change how chronic pain is treated.

The Empowerment and Mindfulness Program for Outpatient Wellness, Education, and Rehabilitation (EMPOWER) is expected to result in reduced pain, improved quality of life, reduced medication use, improved body movement and the ability to return to work for its participants. Once confirmed, these results can be used by Vanderbilt Pain Management faculty to urge Tennessee insurance providers and workers’ compensation programs to provide coverage for programs such as EMPOWER for all individuals with chronic pain.

“In the EMPOWER program, we will use many strategies to teach participants how to reduce pain and anxiety, improve sleep, and facilitate movement in a durable, long-term way,” said Tracy Jackson, M.D., an assistant professor in the Division of Pain Medicine who is leading the program with Tobi Fishel, Ph.D., at the Vanderbilt Center for Integrative Health. “Our goal is to empower patients to take back their own lives and make needed changes to restore their functionality and quality of life.”

In some states, health care providers and workers’ compensation insurers have teamed up to fund rehabilitative programs like EMPOWER that address the pain and disability of injured workers in a “big picture,” holistic way by addressing all aspects of the patients’ physical and emotional health. These programs have demonstrated improvement in both pain and quality of life for individuals with many types of pain, including back/neck pain, headaches, temporomandibular joint (TMJ) pain, fibromyalgia, abdominal pain, pelvic pain, complex regional pain syndrome, chronic post-surgical pain, and neuropathy.

Many patients who complete these programs are able to go back to work and significantly reduce their need for pain medications. However, there is currently no way for patients in Tennessee to benefit from this type of care. Very few programs are available in the United States, and traditional insurers typically do not cover such programs.

Health care economists estimate that chronic pain affects millions of adults in the United States and costs $630 billion per year — more than heart disease, cancer and diabetes combined. Three hundred billion dollars of this total is direct medical costs, with an additional $330 billion related to lost job productivity. Chronic pain, which is often defined as pain that lasts more than 12 weeks, can also lead to chronic stress and increased difficulty in performing self-care, caring for family and meeting job responsibilities. These challenges often lead to frustration, guilt, depression or anxiety. In some cases, individuals being treated for chronic pain can also have adverse medication interactions or a worsening of pain despite treatment.

Techniques include mindfulness training, meditation, cognitive behavioral therapy, yoga, qi gong (a traditional Chinese healing practice of controlled breathing and movement), supervised physical therapy, diet modification, work skills development and medication adjustment. The program also includes education and support for the patients’ families. Following the on-campus sessions, patients are supported for six months with a Web-based coaching program to ensure they have reinforcement and guidance as they incorporate the pain management skills they’ve learned into their daily lives.

EMPOWER participants are currently being recruited from the Vanderbilt Employee Health Plan and workers’ compensation system. Once they are evaluated by the EMPOWER team, patients may be enrolled for a spring start date.

Once the EMPOWER program is completed, changes in pain, function, anxiety, sleep, return-to-work rates and health care expenditures will be analyzed. The pilot data will be presented to insurers to spur expanded services to a wider patient population.

If you or a family member covered by the Vanderbilt Employee Health Plan have chronic pain and are interested in enrolling in EMPOWER, contact the team coordinator at 343-7301.